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      Medicamentos na amamentação: quais as evidências? Translated title: Medications in breastfeeding: what evidence is there?

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          Abstract

          Resumo A amamentação desempenha um papel fundamental nos benefícios para a saúde do recém-nascido e da nutriz. O uso de fármacos durante a amamentação é um tema relevante, visto a frequente necessidade de tratamento farmacológico no período pós-parto. O presente artigo teve como objetivo realizar revisão bibliográfica sobre a eficácia e a segurança dos medicamentos utilizados durante o período de amamentação. Foram consultadas as bases de dados PubMed (National Library of Medicine), Science Direct e Biblioteca Virtual em Saúde (BVS), nas línguas portuguesa, inglesa e espanhola, em artigos publicados no período de 1981-2016. Esta revisão discute o risco do uso de medicamentos na lactação e os efeitos que podem causar no lactente. Poucos fármacos são contraindicados e outros requerem cuidados devido ao risco de efeitos adversos em lactentes ou ainda na supressão do volume de leite materno. Portanto, a divulgação de informações atualizadas para o profissional de saúde avaliar adequadamente os riscos e os benefícios do uso de fármacos durante a amamentação é de vital importância e, dessa forma, contribui para evitar o desmame precoce.

          Translated abstract

          Abstract Breastfeeding plays a fundamental role in the benefits for the health of the newborn child and the nursing mother. The use of medications during breastfeeding is a relevant issue, by virtue of the frequent need for pharmacological treatment in the postpartum period. The scope of this article was to conduct a review of the literature regarding the efficacy and safety of medications used during the breastfeeding period. A search was conducted in the PubMed (National Library of Medicine), ScienceDirect and Biblioteca Virtual em Saúde (BVS) databases for articles published in Portuguese, English and Spanish in the period from 1981 to 2016. This review discusses the risk of the use of medications during lactation and the effects that they may have on the breastfed infant. Few medications are contraindicated and others require care due the risk of adverse effects on breastfed infants or in the suppression of breast milk volume. Therefore, the dissemination of updated information for the health professional to adequately assess the risks and the benefits of the use of medications during breastfeeding is of vital importance, thereby contributing to avoid early weaning.

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          Most cited references70

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          Breastfeeding and asthma and allergies: a systematic review and meta-analysis.

          To systematically review the association between breastfeeding and childhood allergic disease.
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            Reasons for earlier than desired cessation of breastfeeding.

            To describe the prevalence and factors associated with not meeting desired breastfeeding duration. Data were analyzed from 1177 mothers aged ≥18 years who responded to monthly surveys from pregnancy until their child was 1 year old. When breastfeeding stopped, mothers were asked whether they breastfed as long as they wanted (yes or no) and to rate the importance of 32 reasons for stopping on a 4-point Likert scale. Multiple logistic regressions were used to examine the association between the importance of each reason and the likelihood of mothers not meeting their desired breastfeeding duration. Approximately 60% of mothers who stopped breastfeeding did so earlier than desired. Early termination was positively associated with mothers' concerns regarding: (1) difficulties with lactation; (2) infant nutrition and weight; (3) illness or need to take medicine; and (4) the effort associated with pumping milk. Our findings indicate that the major reasons why mothers stop breastfeeding before they desire include concerns about maternal or child health (infant nutrition, maternal illness or the need for medicine, and infant illness) and processes associated with breastfeeding (lactation and milk-pumping problems). Continued professional support may be necessary to address these challenges and help mothers meet their desired breastfeeding duration.
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              Ibuprofen: pharmacology, efficacy and safety.

              This review attempts to bring together information from a large number of recent studies on the clinical uses, safety and pharmacological properties of ibuprofen. Ibuprofen is widely used in many countries for the relief of symptoms of pain, inflammation and fever. The evidence for modes of action of ibuprofen are considered in relation to its actions in controlling inflammation, pain and fever, as well as the adverse effects of the drug. At low doses (800-1,200 mg day(-1)) which in many countries are approved for non-prescription (over-the-counter) sale ibuprofen has a good safety profile comparable with paracetamol. Its analgesic activity is linked to its anti-inflammatory effects and is related to reduction in the ex vivo production in blood of cyclo-oxygenase (COX)-1 and COX-2 derived prostanoids. Higher prescription doses (circa 1,800-2,400 mg day(-1)) are employed long-term for the treatment of rheumatic and other more severe musculo-skeletal conditions. Recent evidence from large-scale clinical trials with the newer coxibs, where ibuprofen was as a comparator, have confirmed earlier studies which have shown that ibuprofen has comparable therapeutic benefits with coxibs and other NSAIDs. For long-term usage (6+ months) there are greater numbers of drop-outs due to reduced effectiveness of therapy, a feature which is common with NSAIDs. Spontaneous reports of adverse events and adverse drug reactions (ADRs) in clinical trails from long-term coxib comparator studies, as well as in epidemiological studies, shows that ibuprofen has relatively low risks for gastro-intestinal (GI), hepato-renal and other, rarer, ADRs compared with other NSAIDs and coxibs. A slightly higher risk of cardiovascular (CV) events has been reported in some, but not all studies, but the risks are in general lower than with some coxibs and diclofenac. The possibility that ibuprofen may interfere with the anti-platelet effects of aspirin, though arguably of low grade or significance, has given rise to caution on its use in patients that are at risk for CV conditions that take aspirin for preventing these conditions. Paediatric use of ibuprofen is reviewed and the main results are that the drug is relatively safe and effective as a treatment of acute pain and fever. It is probably more effective than paracetamol as an antipyretic. This assessment of the safety and benefits of ibuprofen can be summarized thus: (1) Ibuprofen at OTC doses has low possibilities of serious GI events, and little prospect of developing renal and associated CV events. Ibuprofen OTC does not represent a risk for developing liver injury especially the irreversible liver damage observed with paracetamol and the occasional liver reactions from aspirin. (2) The pharmacokinetic properties of ibuprofen, especially the short plasma half-life of elimination, lack of development of pathologically related metabolites (e.g. covalent modification of liver proteins by the quinine-imine metabolite of paracetamol or irreversible acetylation of biomolecules by aspirin) are support for the view that these pharmacokinetic and notably metabolic effects of ibuprofen favour its low toxic potential. (3) The multiple actions of ibuprofen in controlling inflammation combine with moderate inhibition of COX-1 and COX-2 and low residence time of the drug in the body may account for the low GI, CV and renal risks from ibuprofen, especially at OTC doses.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                csc
                Ciência & Saúde Coletiva
                Ciênc. saúde coletiva
                ABRASCO - Associação Brasileira de Saúde Coletiva (Rio de Janeiro, RJ, Brazil )
                1413-8123
                1678-4561
                February 2019
                : 24
                : 2
                : 573-587
                Affiliations
                [1] Passo Fundo Rio Grande do Sul orgnameUniversidade de Passo Fundo Brazil michele_raminelli@ 123456hotmail.com
                Article
                S1413-81232019000200573
                10.1590/1413-81232018242.30052016
                4049168a-be58-4929-be61-3859a8ce5b9c

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 28 October 2016
                : 01 April 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 93, Pages: 15
                Product

                SciELO Public Health

                Categories
                Revisão

                Lactação,Toxicidade,Medications,lactation,toxicity,Medicamentos

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